Changes in reproductive, maternal, and child health in Haiti during the pre- and peri-COVID-19 pandemic / Cambios en materia de salud reproductiva, materna e infantil en los periodos pre y peripandémico de la COVID-19 en Haití / Mudanças na saúde reprodutiva, materna e infantil no Haiti antes e durante a pandemia de COVID-19

[ABSTRACT]. Objective. To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. Methods. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. Results. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneu- mococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. Conclusions. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

[RESUMEN]. Objetivo. Evaluar los cambios en materia de salud reproductiva, materna, neonatal, infantil y adolescente que se produjeron en Haití desde agosto del 2018 hasta septiembre del 2021, antes de la pandemia de COVID-19 y durante ella. Metodología. Estudio retrospectivo basado en datos de vigilancia del sistema único de información de salud de Haití para estudiar los periodos pre y peripandémico. La comparación de los indicadores de salud a nivel nacional de estos dos periodos se realizó mediante pruebas de t de dos muestras para comparar proporciones, y se calculó el promedio de la variación mensual absoluta mediante una regresión ponderada por la varianza. Resultados. Al comparar el periodo prepandémico con el peripandémico, se observó un descenso estadísticamente significativo de la mayoría de los indicadores porcentuales evaluados. Sin embargo, los indicadores porcentuales más afectados fueron los de mujeres embarazadas con cuatro visitas de atención prenatal, con cinco visitas de atención prenatal o más, o que recibieron una segunda dosis de la vacuna contra el tétanos; estos indicadores disminuyeron en más de cuatro puntos porcentuales en el segundo periodo en comparación con el primero. Asimismo, las proporciones de niños y niñas que recibieron las vacunas contra la difteria, el tétanos y la tosferina (DTPa), contra la poliomielitis, antirrotavírica, BCG, y pentavalente también disminuyeron en más de ocho puntos porcentuales. En cambio, la proporción de niños y niñas que recibieron la vacuna antineumocócica conjugada aumentó en más de cuatro puntos porcentuales. También se observó un descenso estadísticamente significativo en el promedio de la variación mensual absoluta de varios indicadores de salud reproductiva e infantil. Conclusiones. La pandemia de COVID-19 puede haber contribuido al descenso observado en varios indica- dores relacionados con la salud reproductiva, materna, neonatal, infantil y adolescente en Haití. Sin embargo, no se puede descartar el papel que ha desempeñado en dicho descenso la crisis sociopolítica y el control ejercido por los grupos armados sobre la población en los últimos tres años.

[RESUMO]. Objetivo. Avaliar mudanças na saúde reprodutiva, materna, neonatal, da criança e do adolescente no Haiti entre agosto de 2018 e setembro de 2021, antes e durante a pandemia de COVID-19. Métodos. Estudo retrospectivo usando dados de vigilância do Sistema Único de Informações de Saúde do Haiti, examinando dois períodos, antes e durante a pandemia de COVID-19. Os indicadores de saúde do país nos dois períodos foram comparados por meio de testes t de duas amostras para proporções, e as variações mensais absolutas médias foram calculadas por meio de regressão linear ponderada. Resultados. Entre o período anterior e o período durante a pandemia de COVID-19, houve uma queda estatisticamente significante na proporção da maioria dos indicadores avaliados. Os indicadores mais afetados, porém, foram as proporções de gestantes com quatro consultas de pré-natal, gestantes com cinco ou mais consultas de pré-natal e gestantes que receberam uma segunda dose de vacina antitetânica, que sofreram uma diminuição de mais de 4 pontos percentuais na comparação entre os dois períodos. Similarmente, as proporções de crianças que receberam vacinas contra difteria, tétano e pertússis (DTPa), BCG, poliomielite, pentavalente e rotavírus também diminuíram em mais de 8 pontos percentuais. Por outro lado, no caso da vacina pneumocócica conjugada houve um aumento de mais de 4 pontos percentuais. Além disso, foi observada uma redução estatisticamente significante nas variações mensais absolutas médias de vários indicadores de saúde reprodutiva e infantil avaliados. Conclusões. A pandemia de COVID-19 pode ter contribuído para a piora observada em vários indicadores de saúde reprodutiva, materna, neonatal, da criança e do adolescente no Haiti. No entanto, não se pode descartar o papel desempenhado pela crise sociopolítica e pelo controle exercido por grupos armados sobre a população nos últimos três anos.

Barriers to pregnancy prevention for adolescents in rural Haiti: perceptions of healthcare providers.

BACKGROUND: Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. METHODS: We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021-03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15-17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. RESULTS: Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. CONCLUSIONS: While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti.

Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: Protocol for a photovoice study of young childbearing people's perspectives of maternal near-misses in northwest Haiti.

INTRODUCTION: Globally, a shift is occurring to recognize the importance of young peoples' health and well-being, their unique health challenges, and the potential they hold as key drivers of change in their communities. In Haiti, one of the four leading causes of death for those 20-24 years old is pregnancy, childbirth, and the weeks after birth or at the end of a pregnancy. Important gaps remain in existing knowledge about youth perspectives of maternal health and well-being within their communities. Youth with lived experiences of maternal near-misses are well-positioned to contribute to the understanding of maternal health in their communities and their potential role in bringing about change. OBJECTIVES: To explore and understand youth perspectives of maternal near-miss experiences that occurred in a local healthcare facility or at home in rural Haiti. METHODS: We will conduct a qualitative, community-based participatory research study regarding maternal near-miss experiences to understand current challenges and identify solutions to improve community maternal health, specifically focused on youth maternal health. We will use Photovoice to seek an understanding of the lived experiences of youth maternal near-miss survivors. Participants will be from La Pointe, a Haitian community served by their local healthcare facility. We will undertake purposeful sampling to recruit approximately 20 female youth, aged 15-24 years. Data will be generated through photos, individual interviews and small group discussions (grouped by setting of near-miss experience). Data generation and analysis are expected to occur over a three-month period. ETHICS AND DISSEMINATION: Ethics approval will be sought from Centre Médical Béraca in La Pointe, Haiti, and from the Hamilton Integrated Research Ethics Board in Hamilton ON, Canada. We will involve community stakeholders, especially youth, in developing dissemination and knowledge mobilisation strategies. Our findings will be disseminated as an open access publication, be presented publicly, at conferences, and defended as part of a doctoral thesis.

Entomological assessment of hessian fabric transfluthrin vapour emanators as a means to protect against outdoor-biting Aedes after providing them to households for routine use in Port-au-Prince, Haiti.

BACKGROUND: A simple treated fabric device for passively emanating the volatile pyrethroid transfluthrin was recently developed in Tanzania that protected against nocturnal Anopheles and Culex mosquitoes for several months. Here these transfluthrin emanators were assessed in Port-au-Prince, Haiti against outdoor-biting Aedes. METHODS: Transfluthrin emanators were distributed to participating households in poor-to-middle class urban neighbourhoods and evaluated once every two months in terms of their effects on human landing rates of wild Aedes populations. A series of three such entomological assessment experiments were conducted, to examine the influence of changing weather conditions, various transfluthrin formulations and emanator placement on protective efficacy measurements. Laboratory experiments assessed resistance of local Aedes aegypti to transfluthrin and deltamethrin, and the irritancy and repellency of the transfluthrin-treated fabric used in the field. RESULTS: Across all three entomological field assessments, little evidence of protection against wild Ae. aegypti was observed, regardless of weather conditions, transfluthrin formulation or emanator placement: A generalized linear mixed model fitted to the pooled data from all three assessment rounds (921 females caught over 5129 hours) estimated a relative landing rate [95% Confidence interval] of 0.87 [0.73, 1.04] for users of treated versus untreated emanators (P = 0.1241). Wild Ae. aegypti in this setting were clearly resistant to transfluthrin when compared to a fully susceptible colony. CONCLUSIONS: Transfluthrin emanators had little if any apparent effect upon Aedes landing rates by wild Ae. aegypti in urban Haiti, and similar results have been obtained by comparable studies in Tanzania, Brazil and Peru. In stark contrast, however, parallel sociological assessments of perspectives among these same end-users in urban Haitian communities indicate strong satisfaction in terms of perceived protection against mosquitoes. It remains unclear why the results obtained from these complementary entomological and sociological assessments in Haiti differ so much, as do those from a similar set of studies in Brazil. It is encouraging, however, that similar contrasts between the entomological and epidemiological results of a recent large-scale assessment of another transfluthrin emanator product in Peru, which indicate they provide useful protection against Aedes-borne arboviral infections, despite apparently providing only modest protection against Aedes mosquito bites.

Haiti's health researchers persevere amid chaos.

"Heroic network" forges ahead as gang violence dominates life and landscape.

Farmer typology and drivers of agricultural mechanization use in Haiti.

Agricultural mechanization is recognized as an important technology to increase agricultural productivity, face labor shortages, and reduce post-harvest loss. However, variations among farms' characteristics and agricultural production systems suggest adopting a targeted strategy in mechanization programs for farmers. This research aimed to answer the following questions in the particular case of Haiti: are there different types of smallholder farmers in terms of mechanization use and socio-economic characteristics? What types of mechanization are used by farmers, and what drives their use among different types of farmers? What are the different types of farms in terms of mechanization use? We used typology construction methodology (principal component analysis (PCA) and hierarchical cluster analysis (HCA)) for a sample of 637 farmers and have identified four different clusters of farmers according to the characteristics of the farms they managed: "Little rain-fed farms" (cluster 1), "Little lowlands farms" (cluster 2), "Medium-sized farms in irrigated plains" (cluster 3), and "Large fragmented mountain farms". Farms in cluster 3 were those who used more agricultural mechanization, and the results of multinomial logistic regression (MNLR) model revealed that the significant drivers of this use were location, access to credit and low food security status. Mechanization use of farms in clusters 1 and 4 was distinctively driven by saving behavior and off-farm income, respectively. In the pooled sample, the drivers of mechanization were: regions or location, age of the farmers, irrigation, livestock, access to credit, off-farm income and food security status. This study contributes to the literature by testing new drivers of agricultural mechanization such as food security status, and off-farm income. The findings can be used to design appropriate mechanization strategies to increase productivity and face labor price/scarcity challenges. They suggest that mechanization policies should focus on agricultural equipment that are adapted to the specificities of the production systems of each farm type, and strengthen access to credit. Otherwise, mechanization will be predominantly used only in irrigated lowlands.

Reducing the Antigen Prevalence Target Threshold for Stopping and Restarting Mass Drug Administration for Lymphatic Filariasis Elimination: A Model-Based Cost-effectiveness Simulation in Tanzania, India and Haiti.

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (GPELF) aims to reduce and maintain infection levels through mass drug administration (MDA), but there is evidence of ongoing transmission after MDA in areas where Culex mosquitoes are the main transmission vector, suggesting that a more stringent criterion is required for MDA decision making in these settings. METHODS: We use a transmission model to investigate how a lower prevalence threshold (<1% antigenemia [Ag] prevalence compared with <2% Ag prevalence) for MDA decision making would affect the probability of local elimination, health outcomes, the number of MDA rounds, including restarts, and program costs associated with MDA and surveys across different scenarios. To determine the cost-effectiveness of switching to a lower threshold, we simulated 65% and 80% MDA coverage of the total population for different willingness to pay per disability-adjusted life-year averted for India ($446.07), Tanzania ($389.83), and Haiti ($219.84). RESULTS: Our results suggest that with a lower Ag threshold, there is a small proportion of simulations where extra rounds are required to reach the target, but this also reduces the need to restart MDA later in the program. For 80% coverage, the lower threshold is cost-effective across all baseline prevalences for India, Tanzania, and Haiti. For 65% MDA coverage, the lower threshold is not cost-effective due to additional MDA rounds, although it increases the probability of local elimination. Valuing the benefits of elimination to align with the GPELF goals, we find that a willingness to pay per capita government expenditure of approximately $1000-$4000 for 1% increase in the probability of local elimination would be required to make a lower threshold cost-effective. CONCLUSIONS: Lower Ag thresholds for stopping MDAs generally mean a higher probability of local elimination, reducing long-term costs and health impacts. However, they may also lead to an increased number of MDA rounds required to reach the lower threshold and, therefore, increased short-term costs. Collectively, our analyses highlight that lower target Ag thresholds have the potential to assist programs in achieving lymphatic filariasis goals.

Haitian coffee agroforestry systems harbor complex arabica variety mixtures and under-recognized genetic diversity.

Though facing significant challenges, coffee (Coffea arabica) grown in Haitian agroforestry systems are important contributors to rural livelihoods and provide several ecosystem services. However, little is known about their genetic diversity and the variety mixtures used. In light of this, there is a need to characterize Haitian coffee diversity to help inform revitalization of this sector. We sampled 28 diverse farms in historically important coffee growing regions of northern and southern Haiti. We performed KASP-genotyping of SNP markers and HiPlex multiplex amplicon sequencing for haplotype calling on our samples, as well as several Ethiopian and commercial accessions from international collections. This allowed us to assign Haitian samples to varietal groups. Our analyses revealed considerable genetic diversity in Haitian farms, higher in fact than many farmers realized. Notably, genetic structure analyses revealed the presence of clusters related to Typica, Bourbon, and Catimor groups, another group that was not represented in our reference accession panel, and several admixed individuals. Across the study areas, we found both mixed-variety farms and monovarietal farms with the historical and traditional Typica variety. This study is, to our knowledge, the first to genetically characterize Haitian C. arabica variety mixtures, and report the limited cultivation of C. canephora (Robusta coffee) in the study area. Our results show that some coffee farms are repositories of historical, widely-abandoned varieties while others are generators of new diversity through genetic mixing.

Ethics in Mental Health Research with Haitian Migrants: Lessons from a Community-Based Study in Santiago, Chile.

Migration research poses several unique challenges and opportunities. Conducting ethical global health practice, especially when studying migrant mental health, is of particular concern. This article explores seven challenges and lessons learned in our mixed-methods study conducted to assess the impact of the migration experience on Haitian migrants' mental health in Santiago, Chile. The primary challenges were recruiting in a highly mobile population, building trust and community participation, overcoming language barriers, safety considerations during the Covid-19 pandemic, mitigating potential negative impacts of research on the community, providing psychological support, and finding meaningful ways to benefit the community. We propose moving toward a better and more ethical migrant research practice by ensuring language accessibility, hiring community members for the study team, working with local institutions and nongovernmental organizations, and maintaining sustainable connections.

Teacher's social desirability bias and Migrant students: A study on explicit and implicit prejudices with a list experiment.

Scholarly research has consistently shown that teachers present negative assessments of and attitudes toward migrant students. However, previous studies have not clearly addressed the distinction between implicit and explicit prejudices, or identified their underlying sources. This study identifies the explicit and implicit prejudices held by elementary and middle school teachers regarding the learning abilities of an ethnic minority group: Haitian students within the Chilean educational system. We use a list experiment to assess how social desirability and intergroup attitudes toward minority students influence teachers' prejudices. The findings reveal that teachers harbor implicit prejudices towards Haitian students and are truthful in reporting their attitudes, thereby contradicting the desirability bias hypothesis. We suggest that teachers rely on stereotypes associated with the students' nationality when assessing Haitian students' learning abilities. The implications of these results are discussed in relation to theories grounded in stereotypes and intergroup attitudes.

Immigrant-blind care: How immigrants experience the "inclusive" health system as they access care.

A growing body of scholarship examines the varying impact of legal status and race on accessing healthcare. However, a notable gap persists in comprehending the supplementary mechanisms that hinder immigrants' pathway to seek care. Drawing on ethnographic observations in various clinical settings and in-depth interviews with 28 healthcare professionals and 12 documented Haitian immigrants in a city in Upstate New York, between 2019 and 2021, I demonstrate the tension between the conceptualization and implementation of inclusive care practices by healthcare providers. I argue that the mere expansion and adoption of inclusive discourse among providers do not inherently ensure equity and the removal of barriers to healthcare access. This work contributes to the social study of medicine and race and ethnic studies by introducing the innovative concept of "immigrant-blind." Through this concept, the research sheds light on how providers' conceptualization of inclusivity proclaims medical encounters to be devoid of stratifications and rationalizes their practices which mask the profound impact of immigration status and immigration on immigrant health. Furthermore, these practices reinforce existing divisions within care settings and medical encounters, where immigration laws and enforcement practices operate and further exacerbate stratifications. By examining providers' uninformed implementation of culturally competent care practices, the findings reveal that providers stigmatize and essentialize immigrants during medical encounters. This highlights the imperative for a more nuanced and informed approach to healthcare provision, where genuine inclusivity is upheld, and barriers to access are dismantled to foster equitable and dignified healthcare experiences for all.

Informing policy via dynamic models: Cholera in Haiti.

Public health decisions must be made about when and how to implement interventions to control an infectious disease epidemic. These decisions should be informed by data on the epidemic as well as current understanding about the transmission dynamics. Such decisions can be posed as statistical questions about scientifically motivated dynamic models. Thus, we encounter the methodological task of building credible, data-informed decisions based on stochastic, partially observed, nonlinear dynamic models. This necessitates addressing the tradeoff between biological fidelity and model simplicity, and the reality of misspecification for models at all levels of complexity. We assess current methodological approaches to these issues via a case study of the 2010-2019 cholera epidemic in Haiti. We consider three dynamic models developed by expert teams to advise on vaccination policies. We evaluate previous methods used for fitting these models, and we demonstrate modified data analysis strategies leading to improved statistical fit. Specifically, we present approaches for diagnosing model misspecification and the consequent development of improved models. Additionally, we demonstrate the utility of recent advances in likelihood maximization for high-dimensional nonlinear dynamic models, enabling likelihood-based inference for spatiotemporal incidence data using this class of models. Our workflow is reproducible and extendable, facilitating future investigations of this disease system.

Determinants of continued breastfeeding in children aged 12–23 months in three regions of Haiti / Determinantes de la continuación de la lactancia materna en la población infantil de entre 12 y 23 meses en tres regiones de Haití / Determinantes do aleitamento materno continuado em crianças de 12 a 23 meses de idade em três regiões do Haiti

[ABSTRACT]. Objectives To identify the prevalence and determinants of continued breastfeeding in Haitian children aged 12–23 months. Methods Three cross-sectional surveys were conducted yearly during the summers of 2017 to 2019 as part of a 4-year (2016–2020) multisectoral maternal and infant health initiative in the regions of Les Cayes, Jérémie, and Anse d’Hainault in Haiti. A total of 455 children 12–23 months of age and their mothers participated in the study. A child was considered to be continuing breastfeeding if the mother reported giving breast milk in the 24-hour dietary recall. Unadjusted and adjusted prevalence ratios were estimated, and associations were assessed between continued breastfeeding and explanatory factors related to sociodemographic character- istics, household food security, maternal nutrition, and breastfeeding knowledge and practices. Results The prevalence of continued breastfeeding was 45.8%. Continued breastfeeding was significantly more prevalent among younger children, children who did not have a younger sibling, children whose mother was not pregnant, those living in the Jérémie region, children who had been exclusively breastfed for less than 1 month, and children whose mother knew the World Health Organization’s recommendation for continued breastfeeding up to 2 years or beyond. Conclusions The study results highlight the need for geographically equitable access to tailored and adequate health services and education that support breastfeeding in a way that is compatible with the local context.

[RESUMEN]. Objetivos. Determinar la prevalencia y los determinantes asociados a la continuación de la lactancia materna en la población infantil haitiana de entre 12 y 23 meses. Métodos. Durante los veranos del 2017 al 2019 se llevaron a cabo tres encuestas transversales anuales como parte de una iniciativa multisectorial de salud materna e infantil de 4 años (2016 a 2020) en las regiones de Les Cayes, Jérémie y Anse d’Hainault de Haití. En el estudio participaron 455 menores de edades comprendidas entre 12 y 23 meses y sus madres. Se consideró que un menor continuaba con la lactancia materna si, en la evaluación de la alimentación basada en el recuerdo de 24 horas, la madre declaraba la toma de leche materna. Se calcularon los cocientes de prevalencia ajustados y sin ajustar y se evaluó la asociación entre la continuación de la lactancia materna y posibles factores explicativos relacionados con las características sociodemográficas, la seguridad alimentaria de la familia, la nutrición materna y los conocimientos y prácticas en materia lactancia materna. Resultados. La prevalencia de la continuación de la lactancia materna fue del 45,8%. Esta prevalencia fue significativamente mayor cuando se trataba de lactantes de menor edad, cuando no había hermanos menores, cuando la madre no estaba embarazada, en los residentes en la región de Jérémie, cuando había habido una alimentación exclusiva con leche materna durante menos de un mes y cuando la madre conocía la recomendación de la Organización Mundial de la Salud de continuar con la lactancia materna hasta los dos años o más. Conclusiones. Los resultados del estudio ponen de relieve la necesidad de disponer de un acceso geográfico equitativo a unos servicios de salud y una educación que respalden la lactancia materna de una manera compatible con el contexto local.

[RESUMO]. Objetivos Identificar a prevalência e os determinantes do aleitamento materno continuado em crianças haitianas de 12 a 23 meses de idade. Métodos Três pesquisas transversais foram realizadas anualmente nos verões de 2017 a 2019 como parte de uma iniciativa multissetorial de saúde materno-infantil de quatro anos (2016–2020) nas regiões de Les Cayes, Jérémie e Anse d’Hainault no Haiti. Um total de 455 crianças de 12 a 23 meses de idade e suas mães participaram do estudo. Considerou-se que a criança continuava sendo amamentada se a mãe relatasse ter dado leite materno no recordatório alimentar de 24 horas. Foram estimadas as taxas de prevalência não ajustadas e ajustadas e foram avaliadas as associações entre o aleitamento materno continuado e os fatores explicativos relacionados às características sociodemográficas, à segurança alimentar da família, à nutrição materna e aos conhecimentos e práticas de aleitamento materno. Resultados A prevalência de aleitamento materno continuado foi de 45,8%. O aleitamento materno continuado foi significativamente mais prevalente entre crianças mais novas, crianças que não tinham irmão mais novo, crianças cuja mãe não estava grávida, residentes da região de Jérémie, crianças que haviam sido exclusivamente amamentadas por menos de um mês e crianças cuja mãe conhecia a recomendação da Organização Mundial da Saúde de manter o aleitamento materno por 2 anos ou mais. Conclusões Os resultados do estudo destacam a necessidade de acesso geograficamente equitativo a educação e serviços de saúde adaptados e adequados para apoiar o aleitamento materno de forma compatível com o contexto local.

How patients experience respect in healthcare: findings from a qualitative study among multicultural women living with HIV.

BACKGROUND: Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients' views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. METHODS: We analyzed 57 semi-structured interviews conducted at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant's language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about "respect." After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. RESULTS: Results from this study grouped into two overarching classifications: respect manifested in physicians' orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider's orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. CONCLUSIONS: Findings suggest a more robust conception of what 'respect for persons' entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery.

Invisible cancers: Seeing, knowing, enacting and proving cancers in Haiti.

In Haiti, pathological confirmation of a cancer diagnosis is often delayed or impossible, imaging is expensive and imperfect, and many tests are unavailable. Physicians frequently struggle to establish cancers at a level of certainty required by "evidence based" standards, delaying definitive diagnosis and rendering some cancers permanently "suspected." I use 22 months of participant observation at the two largest cancer treatment programs in Haiti, as well as throughout Haiti's fragmented healthcare system, to look closely at processes of diagnosis and management of suspected 'cancers' which may never fully come to be. I argue that as global oncology becomes increasingly standardized, local practices are forced into alignment with a global knowledge basis that governs the knowability/unknowability of cancer. Using three case studies drawn from this work, I examine relationships among visibility, power, expertise and the replication of inequity through the governance of knowledge production. Finally, I examine the implications of these processes for cancer care in the global south.

A pilot study to address the mental health of persons living with lymphatic filariasis in Léogâne, Haiti: Implementing a chronic disease self-management program using a stepped-wedge cluster design.

BACKGROUND: Neglected tropical diseases (NTDs) inflict significant comorbid disability on the most vulnerable communities; yet interventions targeting the mental health of affected communities are lacking. A pilot study to assess the effectiveness of a chronic disease self-management program (CDSMP) was introduced to lymphatic filariasis peer support groups in Léogâne, Haiti. METHODS: Using a closed-cohort stepped-wedge cluster trial design, Hope Clubs were assigned into Arm 1 (n=118 members) and Arm 2 (n=92). Household surveys, measuring self-rated health, depression, disease self-efficacy, perceived social support, and quality of life, were conducted at baseline (before CDSMP); midpoint (after Arm 1/before Arm 2 completed CDSMP); and endpoint (after CDSMP). Non-Hope Club member patients (n=74) were evaluated at baseline for comparison. RESULTS: Fifty percent of Hope Club members (Arm 1: 48.3%, Arm 2: 52.2%) screened positive for depression at baseline, compared with 36.5% of non-Hope Club members. No statistically significant differences were found in outcome measures between intervention observation periods. At endpoint, depressive illness reduced to 28.7% (Arm 1) and 27.6% (Arm 2). CONCLUSIONS: The intervention was feasible to integrate into Hope Clubs, showed overall positive effects and reduced depressive symptoms. More studies are needed to evaluate the efficacy of implementing CDSMP in the NTD context. CONTEXTE: Les maladies tropicales négligées (MTN) infligent d'importantes incapacités comorbides aux communautés les plus vulnérables; pourtant, les interventions ciblant la santé mentale des communautés affectées font défaut. Une étude pilote visant à évaluer l'efficacité d'un programme d'autogestion des maladies chroniques (CDSMP) a été introduite dans des groupes de soutien par les pairs pour la filariose lymphatique à Léogâne, en Haïti. MÉTHODES: Dans le cadre d'un essai en grappe à cohorte fermée, les clubs Hope ont été répartis entre le bras 1 (n=118 membres) et le bras 2 (n=92). Des enquêtes auprès des ménages, mesurant l'auto-évaluation de la santé, la dépression, l'auto-efficacité face à la maladie, le soutien social perçu et la qualité de vie, ont été menées au départ (avant le CDSMP), à mi-parcours (après que le bras 1 / avant que le bras 2 ait terminé le CDSMP) et à la fin (après le CDSMP). Les patients non membres du Hope Club (n=74) ont été évalués au début de l'étude à des fins de comparaison. RÉSULTATS: Cinquante pourcent des membres du Hope Club (bras 1 : 48,3%, bras 2 : 52,2%) ont été dépistés positifs pour la dépression au début de l'étude, contre 36,5% des non-membres du Hope Club. Aucune différence statistiquement significative n'a été constatée dans les mesures des résultats entre les périodes d'observation de l'intervention. À la fin de l'étude, la maladie dépressive était réduite à 28,7% (bras 1) et 27,6% (bras 2). CONCLUSIONS: L'intervention a pu être intégrée dans les clubs Hope, elle a montré des effets globalement positifs et a permis de réduire les symptômes dépressifs. D'autres études sont nécessaires pour évaluer l'efficacité de la mise en œuvre du CDSMP dans le contexte des MTD. ANTECEDENTES: Las enfermedades tropicales desatendidas (ETDs) infligen una importante discapacidad comórbida a las comunidades más vulnerables; sin embargo, faltan intervenciones dirigidas a la salud mental de las comunidades afectadas. Se introdujo un estudio piloto para evaluar la eficacia de un programa de autogestión de enfermedades crónicas (CDSMP, por sus siglas en inglés) en grupos de apoyo entre pares de filariasis linfática en Léogâne, Haití. MÉTODOS: Utilizando un diseño de ensayo por conglomerados de cohortes cerradas escalonadas, los Clubes Esperanza fueron asignados al Grupo 1 (n=118 miembros) y al Grupo 2 (n=92). Se realizaron encuestas en los hogares para medir la autoevaluación de la salud, la depresión, la autoeficacia frente a la enfermedad, el apoyo social percibido y la calidad de vida en la línea de base (antes del CDSMP), en el punto medio (después de que el Grupo 1/antes de que el Grupo 2 completara el CDSMP) y en el punto final (después del CDSMP). Los pacientes que no pertenecían al Club Esperanza (n=74) fueron evaluados al inicio del estudio a modo de comparación. RESULTADOS: El 50% de los miembros del Club Esperanza (Grupo 1: 48,3%, Grupo 2: 52,2%) dieron positivo en depresión al inicio del estudio, en comparación con el 36,5% de los no miembros del Club Esperanza. No se encontraron diferencias estadísticamente significativas en las medidas de resultado entre los periodos de observación de la intervención. Al final, la enfermedad depresiva se redujo al 28,7% (Grupo 1) y al 27,6% (Grupo 2). CONCLUSIONES: La intervención fue factible de integrar en los Clubes Esperanza, mostróefectos positivos generales y redujo los síntomas depresivos. Se necesitan más estudios para evaluar la eficacia de la aplicación del CDSMP en el contexto de las ETD.

A community-engaged approach to translate a Vaccine Hesitancy Scale into Haitian Creole.

OBJECTIVE: Accurately translated health materials are needed to achieve equity in vaccine uptake among U.S. individuals with non-English language preferences. Verbatim translations may not capture the cultural and linguistic vernacular required to understand vaccine hesitancy. We leveraged a community-engaged approach to translate the Vaccine Hesitancy Scale (VHS) into Haitian Creole. METHODS: Following the "WHO Guidelines on Translation and Adaptation of Instruments" and a community-engaged framework, a validated 10-question Vaccine Hesitancy Scale (VHS) underwent forward translation, expert panel review, back translation, and focus group pilot testing. RESULTS: Haitian Creole-speaking translators included two community leaders, one community partner, one study team member, and 13 Haitian, greater Boston-based community members who participated in a focus group to pretest the survey. After four iterations, a linguistic and cultural translation of the VHS was created. CONCLUSION: A community-engaged framework strengthened community partnerships and resulted in a culturally relevant Haitian Creole vaccine hesitancy scale.

Aedes aegypti Knockdown Resistance Mutations and Dengue Virus Infection in Haiti.

Haiti is home to approximately 11 million people and has a high incidence of vector-borne disease, including more than 70,000 cases of dengue per year. Vector control is difficult in Haiti and adulticide spray of malathion is the main method of control employed during the outbreak of disease although pyrethroids are used in both bed net campaigns and in widely available aerosol cans for personal use. However, limited pathogen or insecticide resistance surveillance data are available for making operational decisions. In this study, we assessed Aedes aegypti from serial surveillance collections from 3 locations for the presence of dengue virus serotypes 1-3 (DENV1-3) by polymerase chain reaction and assessed, by melt curve analysis, samples from 10 locations in 2 departments for the presence of two mutations (V1016I and F1534C), that in combination, are linked to strong pyrethroid insecticide resistance. Only one of the 32 tested pools was positive for the presence of dengue virus. The two knockdown resistance (kdr) mutations were present in all locations. The 1016I mutation frequency varied from 0.29 to 0.91 and was in all sites lower than the 0.58-1.00 frequency of the 1534C mutation. We also observed that the genotype homozygous for both mutations (IICC), which has been linked to strong pyrethroid resistance, varied from 13 to 86% in each population. Notably, 3 locations - Ti Cousin and Christianville in Ouest department and Camp Coq in Nord department had more than 30% of the tested population without the presence of kdr mutations. These results indicate that the kdr markers of pyrethroid resistance are present in Haiti, at high frequency in several locations and, based on previous studies linking kdr genotypes and phenotypic resistance, that operational interventions with pyrethroids are not likely to be as effective as expected.